Recent developments in vascular access for hemodialysis

Vascular access surgery is a permanent challenge for the vascular surgeon and is a very dynamic, inter-disciplinary field in modern medicine. High technical skill, extreme care and continuity to gain as much experience as possible are required. Priority should be given to the patients' native vessels. Nevertheless, grafts do have a place provided special attention is paid to the restricted indications. Close co-operation of the vascular surgeon, the nephrologist and the radiologist is essential. The nephrologist is responsible for access surveillance and for early detection of fistula dysfunction. Dialysis related parameters should be observed routinely; clinical examination and if necessary ultrasonographic and angiographic technique will give further information. Recently introduced methods such as permanent central venous catheters and an increasing variety of interventional procedures must be critically evaluated in the future.